#DermJC objectives! #dermatology #dermatologia #medtwitter #FOAMed

@AshleyWysongMD @DermatologyJC ? for @AshleyWysongMD is there a biologic mechanism to explain the differences in the results among the different classes? I.e. is there evidence that HCTZ is a stronger photosensitizer? #dermjc

Thanks for joining our journal club with @DermatologyJC - keep the discussion going! A big thank you to our wonderful guests @AshleyWysongMD and @mahrifai for offering their time and expertise!🎉🌟🎉🌟 #dermtwitter #DermJC #BJDTalks

@DermatologyJC With increased IRR of squamous cell skin cancer a/w HCTZ, I will continue partnering with #PCP colleagues to look for alternative anti-hypertensives, particularly in high-risk skin cancer "chronic disease" patients. #MedTwitter #DermJC #BJDTalks @ACPinternists #dermtwitter

@Nour_Kibbi @DermatologyJC This is very important note for absolute risk increases/reductions as these are dependent on baseline characteristics…can be tough to compare absolute risks. Conditional relative risks can be more transportable assuming needed data given, but without direct comparison it’s hard

@BrJDermatol @DermatologyJC @AshleyWysongMD @mahrifai In an ideal world, other factors that we KNOW increase the risk of skin cancer: history of sunburns, chronic wounds, chronic inflammatory disease, prior radiation use, CLL.

@DermatologyJC I would like to know the length of TIME to develop first #skincancer in this cohort; BCCs and melanomas may take more time to develop based on photosensitivity / UV exposure. SCCs have higher rates of p53 mutations and overall UV signatures (C-T mutations). #DermJC #BJDTalks

Thank you for joining our journal club with @BrJDermatol! Feel free to keep the conversation going. #BJDTalks #DermJC

Q6: Does this paper change your practice? #BJDTalks #DermJC

@AshleyWysongMD @DermatologyJC @UNMCDermatology Fascinating re: hypothyroidism. Do you think this is because of clinicians being uncertain of their clinical lymph node exam?

@DermatologyJC Our group @UNMCDermatology has published several papers showing association between #hypothyroidism and SCC and metastasis -- I would love to see this patient characteristic included in the analysis on HCTZ and skin cancer. https://t.co/5ViywnQm1M . #DermJC #BJDTalks

@DermatologyJC In all epidemiologic studies of skin cancer, I like to see data on family history of skin cancer & sun exposure #UV but this is impossible without patient questionnaires and is ripe for #recallbias #DermJC #BJDTalks

Q5: The paper suggests bendroflumethiazide as a safer alternative to hydrochlorothiazide. Do you agree? #BJDTalks #DermJC

@JonnyGucks @mahrifai @DermatologyJC @cotter_chantal bendroflumethiazide for the win!

Question 4⃣: hydrochlorothiazide and BCC risk...how do you interpret the finding explained below? 🗣️follow @DermatologyJC and use the hashtags #DermJC #BJDTalks to track the discussion @AshleyWysongMD @mahrifai

@RoxanaDaneshjou @DermatologyJC @RoxanaDaneshjou -- that is the million dollar question! How do we partner with #PCPs to help in #skincancer prevention efforts? #sunsafety #preventioniskey #HCTZ

@JonnyGucks @DermatologyJC @cotter_chantal Very cool. I'm sure prescribing patterns differ even WITHIN the UK, but I thought it was fascinating what small % HCTZ constituted among all thiazide monotherapy prescriptions in the UK (3.6% to be exact). Don't we use HCTZ all the time in the US, @mahrifai? #BJDTalks #DermJC

Q4: Short-term use of hydrochlorothiazide was associated with an increased risk of BCC but not long-term use. How do you interpret this finding? #DermJC #BJDTalks

@DermatologyJC In general, increased risk of SCCs in OTRs are 65-100x versus general public. This study excluded OTRs and found a weight IRR of 1.95 for HCTZ, would be interesting to look a subset analysis in this cohort of OTRs + HCTZ vs. OTRs + CCBs --> skin cancer risk?

@DermatologyJC With the main caveat of cross study comparisons, for context, every 6 months on voriconazole (another presumed photosensitizer, mechanism not fully elucidated) confers increased relative risk of 1.74. (Tang H et al., JAAD, 2019). #DermJC #BJDTalks

Primary care doctors, do you ask about a history of skin cancer prior to start a thiazide?